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Left atrial spindle cell sarcoma: a case report

BACKGROUND: Primary cardiac spindle cell sarcomas are extremely rare with only a few cases reported. They are frequently misdiagnosed on cardiac magnetic resonance (CMR) imaging as benign myxoma or thrombi and the suspicion of a malignant sarcoma arises only during surgery. This case report describe...

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Autores principales: Braams, Natalia J, Kaffka Genaamd Dengler, Selma E, Rutten, Emma G G M, de Boer, Karin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439379/
https://www.ncbi.nlm.nih.gov/pubmed/31020250
http://dx.doi.org/10.1093/ehjcr/ytz005
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author Braams, Natalia J
Kaffka Genaamd Dengler, Selma E
Rutten, Emma G G M
de Boer, Karin
author_facet Braams, Natalia J
Kaffka Genaamd Dengler, Selma E
Rutten, Emma G G M
de Boer, Karin
author_sort Braams, Natalia J
collection PubMed
description BACKGROUND: Primary cardiac spindle cell sarcomas are extremely rare with only a few cases reported. They are frequently misdiagnosed on cardiac magnetic resonance (CMR) imaging as benign myxoma or thrombi and the suspicion of a malignant sarcoma arises only during surgery. This case report describes a case of cardiac spindle cell sarcoma diagnosed after surgery, where the initial diagnostic possibilities included an intramural thrombus and a cardiac myxoma. CASE SUMMARY: A 57-year-old woman was referred to our hospital for evaluation of a possible recurrent myxoma in the left atrium on echocardiography. Cardiac magnetic resonance imaging confirmed these masses as mural thrombotic masses, with a possible remnant of myxoma. After 2 months of anticoagulation therapy, the masses did not decrease in size on CMR imaging, and surgical removal was indicated. The atrial masses were surgically resected together with a large part of the left atrium. Histological examination showed spindle cell sarcoma. Unfortunately, the resection margins were positive and it was not possible to remove more atrium. PET-CT revealed metastasis in the right femur. The patient passed away 1 year after surgery. DISCUSSION: The rarity of spindle cell sarcoma and its similarities to benign cardiac myxoma and thrombi on echocardiography and CMR imaging present a diagnostic challenge when evaluating patients pre-operatively. Therefore, a malignant spindle cell sarcoma may only be diagnosed during surgery, after histological examination.
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spelling pubmed-64393792019-04-24 Left atrial spindle cell sarcoma: a case report Braams, Natalia J Kaffka Genaamd Dengler, Selma E Rutten, Emma G G M de Boer, Karin Eur Heart J Case Rep Case Reports BACKGROUND: Primary cardiac spindle cell sarcomas are extremely rare with only a few cases reported. They are frequently misdiagnosed on cardiac magnetic resonance (CMR) imaging as benign myxoma or thrombi and the suspicion of a malignant sarcoma arises only during surgery. This case report describes a case of cardiac spindle cell sarcoma diagnosed after surgery, where the initial diagnostic possibilities included an intramural thrombus and a cardiac myxoma. CASE SUMMARY: A 57-year-old woman was referred to our hospital for evaluation of a possible recurrent myxoma in the left atrium on echocardiography. Cardiac magnetic resonance imaging confirmed these masses as mural thrombotic masses, with a possible remnant of myxoma. After 2 months of anticoagulation therapy, the masses did not decrease in size on CMR imaging, and surgical removal was indicated. The atrial masses were surgically resected together with a large part of the left atrium. Histological examination showed spindle cell sarcoma. Unfortunately, the resection margins were positive and it was not possible to remove more atrium. PET-CT revealed metastasis in the right femur. The patient passed away 1 year after surgery. DISCUSSION: The rarity of spindle cell sarcoma and its similarities to benign cardiac myxoma and thrombi on echocardiography and CMR imaging present a diagnostic challenge when evaluating patients pre-operatively. Therefore, a malignant spindle cell sarcoma may only be diagnosed during surgery, after histological examination. Oxford University Press 2019-02-06 /pmc/articles/PMC6439379/ /pubmed/31020250 http://dx.doi.org/10.1093/ehjcr/ytz005 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Braams, Natalia J
Kaffka Genaamd Dengler, Selma E
Rutten, Emma G G M
de Boer, Karin
Left atrial spindle cell sarcoma: a case report
title Left atrial spindle cell sarcoma: a case report
title_full Left atrial spindle cell sarcoma: a case report
title_fullStr Left atrial spindle cell sarcoma: a case report
title_full_unstemmed Left atrial spindle cell sarcoma: a case report
title_short Left atrial spindle cell sarcoma: a case report
title_sort left atrial spindle cell sarcoma: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439379/
https://www.ncbi.nlm.nih.gov/pubmed/31020250
http://dx.doi.org/10.1093/ehjcr/ytz005
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